Provider Demographics
NPI:1720769607
Name:SPARK WELLNESS, LLC
Entity type:Organization
Organization Name:SPARK WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HORWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CAADC, CCS
Authorized Official - Phone:215-354-7700
Mailing Address - Street 1:301 OXFORD VALLEY RD STE 1302A
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7706
Mailing Address - Country:US
Mailing Address - Phone:866-301-6055
Mailing Address - Fax:
Practice Address - Street 1:301 OXFORD VALLEY RD STE 1302A
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7706
Practice Address - Country:US
Practice Address - Phone:866-301-6055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty